1,3-Diphenylureido hydroxamate as a promising scaffold for generation of potent antimalarial histone deacetylase inhibitors

We report a series of 1,3-diphenylureido hydroxamate HDAC inhibitors evaluated against sensitive and drug-resistant P. falciparum strains. Compounds 8a-d show potent antiplasmodial activity, indicating that a phenyl spacer allows improved potency relative to cinnamyl and di-hydrocinnamyl linkers. In vitro, mechanistic studies demonstrated target activity for PfHDAC1 on a recombinant level, which agreed with cell quantification of the acetylated histone levels. Compounds 6c, 7c, and 8c, identified as the most active in phenotypic assays and PfHDAC1 enzymatic inhibition. Compound 8c stands out as a remarkable inhibitor, displaying an impressive 85% inhibition of PfHDAC1, with an IC50 value of 0.74 µM in the phenotypic screening on Pf3D7 and 0.8 µM against multidrug-resistant PfDd2 parasites. Despite its potent inhibition of PfHDAC1, 8c remains the least active on human HDAC1, displaying remarkable selectivity. In silico studies suggest that the phenyl linker has an ideal length in the series for permitting effective interactions of the hydroxamate with PfHDAC1 and that this compound series could bind as well as in HsHDAC1. Taken together, these results highlight the potential of diphenylurea hydroxamates as a privileged scaffold for the generation of potent antimalarial HDAC inhibitors with improved selectivity over human HDACs.

Use of antibiotics and the prevalence of antibiotic-associated diarrhoea in patients with spinal cord injuries: an international, multi-centre study

BACKGROUND

Little is known about the use of antibiotics and the extent of antibiotic-associated diarrhoea (AAD) in patients with spinal cord injuries (SCIs).

AIMS

To record the use of antibiotics, establish the prevalence of AAD and Clostridium difficile infection (CDI), and assess if there was any seasonal variation in antibiotic use and incidence of AAD in patients with SCIs.

METHODS

A retrospective study was conducted in six European SCI centres between October 2014 and June 2015. AAD was defined as two or more watery stools (Bristol Stool Scale type 5, 6 or 7) over 24 h.

FINDINGS

In total, 1267 adults (median age 54 years, 30.7% female) with SCIs (52.7% tetraplegia, 59% complete SCI) were included in this study. Among the 215 (17%) patients on antibiotics, the top three indications for antibiotics were urinary tract infections (UTIs), infected pressure ulcers and other skin infections. Thirty-two of these 215 (14.9%) patients developed AAD and two patients out of the total study population (2/1267; 0.16%) developed CDI. AAD was more common in summer than in spring, autumn or winter (30.3% vs 3.8%, 7.4% and 16.9%, respectively; P<0.01). AAD was associated with age ≥65 years, tetraplegia, higher body mass index, hypoalbuminaemia, polypharmacy, multiple antibiotic use and high-risk antibiotic use. Summer and winter seasons and male sex were identified as independent predictors for the development of AAD.

CONCLUSION

This survey found that AAD is common in patients with SCIs, and UTI is the most common cause of infection. Summer and winter seasons and male sex are unique predictors for AAD. Both AAD and UTIs are potentially preventable; therefore, further work should focus on preventing the over-use of antibiotics, and developing strategies to improve hospital infection control measures.

Neuropsychological function in nondemented carriers of presenilin-1 mutations

BACKGROUND

Prospective and case-control studies have demonstrated that memory loss and executive dysfunction occur early in Alzheimer disease (AD).

OBJECTIVE

To investigate these observations by the study of persons at risk for autosomal dominant forms of AD.

METHODS

Neuropsychological and genetic tests were performed on 51 nondemented at-risk members of 10 Mexican families with two distinct presenilin-1 (PS1) mutations. Test scores were compared between PS1 mutation carriers (MCs; n = 30) and noncarriers (NCs; n = 21) by analyses of variance, co-varying for family and specific mutation. Regression analyses were performed, taking into account age relative to the median age at dementia diagnosis in the family (adjusted age), gender, Beck Depression Inventory (BDI) scores, education, and number of APOE epsilon4 alleles. Subjects were divided into age tertiles and scores compared within these groups. Composite scores for Verbal Memory, Executive Function/Working Memory, Language, and Visuospatial Function were created, and these scores compared between MCs and NCs.

RESULTS

MCs performed worse than NCs on the Mini-Mental State Examination, Trails Making Tests A and B, Delayed Recall of a 10-Word List, and Wechsler Adult Intelligence Scale WAIS Block Design. In multiple linear regression analyses, BDI score, gender, and number of APOE epsilon4 alleles did not consistently affect test scores. The differences seen between MCs and NCs were due to differences in the oldest tertile. MCs had lower Visuospatial and Executive Function/Working Memory but not Verbal Memory or Language composite scores.

CONCLUSIONS

This study is consistent with findings in sporadic Alzheimer disease of early problems with memory, visuospatial function, and particularly with executive function in PS1 mutation carriers. Depression, gender, and presence of an APOE epsilon4 allele did not demonstrate large influences on neuropsychological performance.

Female preclinical presenilin-1 mutation carriers unaware of their genetic status have higher levels of depression than their non-mutation carrying kin

OBJECTIVES

To study depressive symptoms in preclinical presenilin-1 (PS1) related Alzheimer's disease.

METHODS

Participants were 33 Mexican women at risk for inheriting PS1 mutations who were not demented. They were interviewed, underwent cognitive testing, and completed the Beck depression inventory (BDI). PS1 mutation status was determined. Mean BDI scores were compared between PS1 mutation carriers and non-carriers. The percentage of subjects who reported seeing a psychiatric professional, and the percentage complaining of memory loss were compared between groups. Regression analysis was used to determine whether mutation status predicted BDI scores after adjusting for age, education, mini-mental state examination, and subjective memory function.

RESULTS

PS1 mutation carriers (n = 17) scored significantly higher than non-carriers (n = 16) on the BDI (mean score, 14.4 v 6.5, p = 0.017); 24% of mutation carriers and 12.5% of non-carriers admitted having sought help from a psychiatric professional (NS). Mutation status remained a significant predictor of BDI scores after adjusting for potential covariates. Though not demented, mutation carriers tended to score lower than non-carriers on several neuropsychological tests.

CONCLUSIONS

Depressive symptoms can occur early in the course of PS1 related Alzheimer's disease, at least in women. This supports the hypothesis that depression may occur as a direct result of the neuropathology underlying Alzheimer's disease.

[Pleural effusion and complicated empyema in children. Evolution and prognostic factors]

BACKGROUND

Complicated pleural empyema has a torpid and longer clinical evolution, requiring in some patients surgical management. The predictive factors for surgical treatment are not well known.

AIM

To search for clinical, laboratory or radiological predictors for the requirement of surgical treatment in pediatric patients with empyema.

PATIENTS AND METHODS

A retrospective review of the charts of 108 patients hospitalized for pneumonia plus pleural effusion at the Pediatric Service of the Catholic University Hospital between January 1985 and July 2000.

RESULTS

Eighty one patients had complete radiological evaluation and pleural fluid biochemical analysis. Forty nine (60%) fulfilled the criteria for empyema and 32 (40%) for an exudate. Thirteen patients with empyema required surgery and 36 were treated medically. The mean age was 3 years (range 9 months-6 years) for the surgically treated and 4 years (range 12 months-14 years) for the non-surgical group. The male/female ratio was 5:1 in the surgical group and 1:1 for the non-surgical group. Pleural fluid cultures were positive in 21 of 79 patients. Streptococcus pneumonia was the most frequently isolated agent. No significant differences were found between groups for the average days of fever prior to the diagnosis or total days of fever, days of hospital stay, pleural fluid pH (6.8 and 7.0 respectively) and glucose (21 and 31 mg/dl respectively). No differences were either observed for pleural fluid risk factors (pH < 7 and glucose < 20 mgdl), the presence of extensive pleural effusions, pleural loculations or bands on pleural ultrasonography and positive Gram stain or cultures in the pleural fluid. Surgical patients required oxygen for more days than medical patients (7.7 and 5.1 days; p = 0.037).

CONCLUSIONS

This study failed to find predictive clinical, radiological or pleural fluid parameters, for the requirement of surgical treatment of empyema.

Prevalence of intimate partner abuse among nurses and nurses' aides in Mexico

BACKGROUND

Nurses are the health professionals most frequently involved in the diagnosis and treatment of victims of family violence (FV). Understanding their personal experience with victimization is the key to shaping an appropriate role as advocates for medical recognition of FV and as integral members of the screening teams. We sought to determine the lifetime prevalence of intimate partner abuse among them and identify its risk factors.

METHODS

In our cross-sectional study, 1,150 registered nurses and nurses' aides at 11 urban hospitals in Mexico City self-administered an anonymous survey. We calculated descriptive statistics, Fisher exact tests, and multivariate logistic regression models to analyze physical, sexual, and emotional abuse during adulthood.

RESULTS

Physical/sexual abuse during adulthood was 13% for nurses' aides and 18% for nurses. Similar proportions (13% of nurses' aides and 14% of nurses) also reported childhood physical/sexual abuse. Additional respondents (39% nurses' aides, 42% nurses) reported emotional abuse during adulthood. Detecting no significant differences in abuse patterns between the two groups, we combined occupations for all subsequent analyses. Being separated or divorced (vs. married) (Apr = 3.41, 95% confidence interval (CI): 1.81-6.44) and having suffered physical/sexual abuse during childhood (Apr = 3.39, 95% CI: 2.26-5.08) were associated with physical/sexual abuse in adulthood. The same variables were associated with adult emotional abuse (separated/divorced: Apr = 5.33, 95% CI: 2.61-10.85, and childhood physical/sexual abuse: Apr = 2.58, 95% CI: 1.79-3.75). Younger women (between the ages of 23 and 28 years) reported more emotional abuse (Apr = 2.10, 95% CI: 1.48-2.98).

CONCLUSIONS

Counseling for abused nursing staff may help break the cycle. Physical/sexual partner abuse among nurses appears lower than among the general Mexican population, but remains worrisome. Battling childhood abuse might prevent intimate partner violence.

[Clinical experience in home care of children with tracheostomy]

BACKGROUND

Home care of tracheostomized children is considered a safe and low-cost alternative.

AIM

To report the experience with tracheostomized children at the Pediatric Respiratory Unit of the Catholic University Hospital.

PATIENTS AND METHODS

The records of 16 children (9 male) with tracheostomy (TQ) in home care between 1992 and 1998 were reviewed.

RESULTS

The average age at the moment of TQ was 9 months (range 1-30 months) and the postoperative hospital management period was 5 months (range 1-11 months). The average age at discharge was 13 months (range 3 to 30 months). Surgical indication were upper airway obstruction (congenital or acquired subglottic stenosis in three, upper airway malformations in one, vocal cord palsy in one and tracheobronchomalacia in one) and chronic assisted ventilation (severe tracheobronchomalacia in four, pulmonary hypoplasia in two, myopathy in one, central nervous injury in one and bronchopulmonary dysplasia in one). Overall rate complications were 2 per 100 tracheostomy months during home care and 8 per 100 tracheostomy months during hospital care. No tracheostomy-related deaths were observed. A parenteral education program to teach about tracheostomy management and cardiopulmonary resuscitation was carried out.

CONCLUSIONS

Tracheostomized children can be safely managed at home.

Domestic violence against patients with chronic neurologic disorders

BACKGROUND

Violent behavior caused by some neurologic disorders has been widely studied. However, the inverse, violence suffered by patients with neurologic disorders, has not been reported. Brain disorders frequently produce a high frequency of social, psychological, or physical disabilities that could leave patients vulnerable to domestic violence.

OBJECTIVES

To determine the prevalence of domestic violence among female patients with chronic neurologic disorders and to identify possible diagnoses associated with the battering syndrome.

DESIGN

Cross-sectional, self-administered, anonymous survey.

SETTING

Tertiary care center for neurologic disorders in Mexico.

PATIENTS

One thousand consecutive adult female patients with neurologic disorders, separated by medical diagnosis of functional or structural disorders.

MAIN OUTCOME MEASURES

A modified version of the Abuse Assessment Screen was administered. Statistical analysis was performed using Poisson regression to estimate the prevalence ratio by univariate and multivariate analysis.

RESULTS

Overall, 31.2% of women with chronic neurologic disorders were survivors of domestic violence. When separated according to the nature of the disease, 35.3% of patients with functional disorders and 28.1% of patients with brain structural disorders were victims of domestic violence (P = .02). Risk increased in relation to duration of marriage, number of children, and work outside the home.

CONCLUSIONS

One third of female patients with chronic neurologic disorders in Mexico suffer domestic violence. A higher frequency of domestic violence was endured by patients with diagnosis of functional disorders as essential epilepsy, headache, migraine, trigeminal pain, depression, or vertigo. The possibility of domestic violence should be routinely explored in patients with chronic neurologic disorders of functional origin.

Inhibition of the transepithelial potential difference and short circuit current in the isolated frog skin by alloxan

1. Electrical parameters: short circuit current (SCC), transepithelial potential difference (PD) and electrical resistance (R) were measured in isolated frog skin (Rana pipiens) in the presence and in the absence of alloxan. 2. Alloxan decreased SCC and PD in a concentration-dependent pattern, while R remained unchanged. 3. The effect on SCC and PD was observed after 25 min of exposure to the drug. Maximal average effect was 20% in SCC and 17.5% in PD. 4. These results suggest that alloxan decreased epithelial sodium transport, through interference with the activity of the Na(+)-K(+)-ATPase.

The frequency and economic burden of genetic disease in a pediatric hospital in Mexico City

A survey of 2,945 admissions to the National Institute of Pediatrics, México, was undertaken to document the frequency and burden of genetic disorders. Patients were classified into five categories: single gene disorders; chromosomal disorders; complex genetic etiology; unknown etiology, and nongenetic disorders. Of all admissions studied, 4.3% had a genetic disease (categories 1 and 2); 33.5% had a partly genetic condition (category 3); 13.8% had a disorder of unknown etiology; and 48.4% had an environmental disease. In terms of economic burden, patients with genetic or partly genetic disorders came more frequently from outside the city and had more and longer admissions with a higher number of surgeries. The results suggest that genetic disease, although less frequent than disease caused by environmental conditions, lays a considerable financial burden on the hospital and on the affected families. The need to create genetic units in developing countries is emphasized.